肝脏炎性假瘤的超声造影表现及其诊断价值  

Contrast-enhanced ultrasound findings of hepatic inflammatory pseudotumors and their diagnostic value

作　　者：罗敏华 王文平 孔文韬[1] Minhua Luo;Wenping Wang;Wentao Kong(Department of Ultrasound,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210009,China;Department of Ultrasound,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]南京大学医学院附属鼓楼医院超声科,南京210009 [2]复旦大学附属中山医院超声科,上海200032

出　　处：《中华医学超声杂志（电子版）》2024年第3期297-303,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：“十三五”南京市卫生青年人才培养工程资助项目(QRX17011)。

摘　　要：目的分析肝脏炎性假瘤的超声造影表现,并探讨超声造影对炎性假瘤的诊断价值。方法回顾性分析南京鼓楼医院和复旦大学附属中山医院自2012年12月至2022年12月76例经病理证实的肝脏炎性假瘤患者的临床及超声造影资料,总结其常规超声及超声造影的特点并评价其诊断准确率。结果76例肝脏占位超声造影动脉期可见5种增强模式:整体均匀增强(27.63%,21/76)、整体不均匀增强(26.32%,20/76)、周边环状增强(26.32%,20/76)、蜂窝状增强(14.47%,11/76)和三期无增强(5.26%,4/76)。强化程度为45例高增强,22例等增强,5例低增强,4例无增强。病灶在超声造影门脉期及延迟期呈低回声、混合回声、等回声和无回声的分别有55例、15例、2例、4例。所有病例的开始增强时间、达峰时间和廓清时间分别为15.0(13.0,19.3)s、22.0(19.8,26.3)s、35.0(30.0,50.0)s。有56例(73.68%)在注射造影剂后60 s内出现廓清,呈现“快进快退”模式,其中45例病灶在45 s内廓清。根据超声结果、临床表现及实验室检查,48例(63.16%)病灶被正确诊断为炎性假瘤,而其余28例被误诊为恶性肿瘤(30.26%,23/76)或诊断不确定(6.58%,5/76)。结论肝脏炎性假瘤在疾病进展过程中因病理不同而表现出多种强化模式,超声造影特征对其诊断具有一定的价值,同时需结合临床表现与实验室检查有助于提高诊断准确率。Objective To analyze the contrast-enhanced ultrasound(CEUS)findings of hepatic inflammatory pseudotumors(IPTs),and to assess their diagnostic value.Methods From December 2012 to December 2022,the clinical and contrast-enhanced ultrasound data of 76 patients with pathologically confirmed hepatic IPTs at Nanjing Drum Tower Hospital and Shanghai Zhongshan Hospital were retrospectively analyzed.The characteristics of conventional ultrasound(US)and contrast-enhanced ultrasound were summarized and their diagnostic accuracy was evaluated.Results Five enhancement patterns were observed in 76 liver nodules:homogeneous enhancement(n=21,27.63%),heterogeneous enhancement(n=20,26.32%),rim-like enhancement(n=20,26.32%),honeycomb enhancement(n=11,14.47%),and no enhancement during vascular phases(n=4,5.26%).The degree of enhancement was hyper-enhancement in 45 cases,iso-enhancement in 22,hypo-enhancement in 5,and no enhancement in 4.The number of nodules that were hypoechoic,mixed,isoechoic,and anechoic in the portal and delayed phases was 55,15,2,and 4,respectively.The median initial enhancement time,time to peak,and wash-out time were 15.0(13.0,19.3)s,22.0(19.8,26.3)s,and 35.0(30.0,50.0)s,respectively.Fifty-six nodules(73.68%)were hypoechoic within 60 s after contrast medium injection,showing a"quick wash-in and wash-out"pattern,and 45 nodules were hypoechoic within 45 s.Based on ultrasonography,clinical findings,and laboratory examination,48 nodules(63.16%)were correctly diagnosed as IPTs,while the remaining 28 cases were misdiagnosed as malignancy(n=23,30.26%)or had an uncertain diagnosis(n=5,6.58%).Conclusion Hepatic IPTs show various enhancement patterns due to pathological changes during the progression of the disease.The features of CEUS have appreciated value in the diagnosis of IPT,and the combination of clinical manifestations and laboratory examination helps to improve the diagnosis coincidence rate.

关 键 词：超声造影 肝脏 炎性假瘤 增强模式 鉴别诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735[医药卫生—诊断学]